Provider Demographics
NPI:1700584026
Name:KIZITO, TANAH
Entity Type:Individual
Prefix:
First Name:TANAH
Middle Name:
Last Name:KIZITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 S CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7333
Mailing Address - Country:US
Mailing Address - Phone:646-400-4558
Mailing Address - Fax:
Practice Address - Street 1:736 S CATALINA ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7333
Practice Address - Country:US
Practice Address - Phone:646-400-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NH18591700374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide